Kidney Week

Abstract: SA-OR104

AKI and CKD Incidence and Progression: The ASSESS-AKI Study

Session Information

• What Happens After AKI
  November 04, 2017 | Location: Room 295, Morial Convention Center
  Abstract Time: 05:06 PM - 05:18 PM

Category: Acute Kidney Injury

• 003 AKI: Clinical and Translational

Authors

• Ikizler, Talat Alp, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Talat Alp Ikizler, MD, FASN

• Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States

Alan S. Go,

• Chinchilli, Vernon M., Penn State College of Medicine, Hershey, Pennsylvania, United States

Vernon M. Chinchilli,

• Himmelfarb, Jonathan, Kidney Research Institute, Seattle, Washington, United States

Jonathan Himmelfarb,

• Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States

Paul L. Kimmel,

• Kaufman, James S., VA New York Harbor Healthcare System, New York, New York, United States

James S. Kaufman,

• Parikh, Chirag R., Yale University and VAMC, New Haven, Connecticut, United States

Chirag R. Parikh,

Group or Team Name

• ASSESS-AKI

Background

Retrospective studies suggest AKI associates with risk of CKD and faster CKD progression, but there are few prospective data. We prospectively evaluated whether AKI independently increases risks of incident and progressive CKD.

Methods

Hospitalized adults with and without AKI were enrolled in a parallel matched cohort from 4 centers between 2009-2015 and had an outpatient baseline visit within 3 months post-discharge. AKI (≥50% relative or absolute increase ≥ 0.3mg/dL in peak inpatient SCr compared to baseline outpatient SCr) was identified during the index hospitalization. AKI and non-AKI participants were matched on center and baseline CKD status (using eGFR<60ml/min/1.73m²). CKD incidence was defined as ≥25% decrease in baseline eGFR and eGFR <60 ml/min/1.73m². In patients with CKD at index hospitalization, CKD progression was defined as ≥50% decrease in eGFR from baseline, reaching eGFR <15 ml/min/1.73m² or receiving renal replacement therapy. Multivariable Cox regression was used to examine association of AKI with CKD.

Results

A total of 769 AKI and 769 well-matched non-AKI adults were enrolled. During follow-up, CKD incidence rate was 66 per 1000 p-y in AKI group compared with 26 per 1000 p-y in matched non-AKI adults (P<0.0001). In patients with underlying CKD, CKD progression rate was 35 per 1000 p-y in AKI group compared with 14 per 1000 p-y in matched non-AKI adults (P<0.0001). In multivariable analyses, AKI was associated with an over threefold higher adjusted rate of CKD incidence (adjusted hazard ratio [aHR] 3.17, 95% CI: 2.25-4.46), and an over twofold higher adjusted rate of CKD progression (aHR 2.03, 1.11-3.74).

Conclusion

AKI independently increases the post-discharge risks of incident CKD and CKD progression. Future studies should assess if early surveillance of and intervention in AKI patients with or without underlying CKD can prevent CKD incidence and progression post-AKI.

Funding

• NIDDK Support